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Membership Application
Organization Name:_________________________________________________________________________________________________
Street Address:__________________________________________________________________	 Suite: _____________________________
City:_____________________________________	 State:________________	 Zip:__________--_______ County:_____________________
Mailing Address: (if different than street address) ________________________________________________________________________________
City:_____________________________________	 State:________________	 Zip:__________--_______ County:_____________________
Organizational E-mail Address: (example: info@mycompany.com) __________________________________________________________________
Contact E-mail Address: _____________________________________________________________________________________________
Web Address:______________________________________________________________________________________________________
Main Telephone:_________________________ Fax:______________________________________ Cell Phone:________________________
Designated Member: 	 Mr.	 Ms.	 Mrs.	 Dr.
First Name:___________________________ Last Name:___________________________ Title: ____________________________________
Home Address:_____________________________________________________________________________________________________
City:_____________________________________	 State:________________	 Zip:_________________ County:_____________________
Business Classification - Print (will be used in printed Membership Directory and on Web site): 	________________________________________________
Business Classification - Web (will be used on Web site only): _____________________________________________________________________
Number of permanent full-time employees in Las Vegas area: ______________ part-time: _____________
(By signing, you are stating that you have read and agree to the terms and conditions on the reverse side.)
Thank you for your support and interest in the Las Vegas Chamber of Commerce. Please keep the last copy of the application for your tax records.
* BIZPAC contribution is voluntary and may not be declared as a business expense.
Las Vegas Chamber of Commerce
Attn: Sales Department
6671 Las Vegas Blvd. South | Suite 300 | Las Vegas, NV 89119
Phone:702.641.5822 | Fax: 702.735.2011 | www.lvchamber.com
Membership #:
__________________
App. Date:
__________________
Office Use Only
Annual Dues:			 $______________
Admin. Fee: (first year only)	 $______________
Per Employee Fee:		 $______________
BIZPAC Contribution*:		 $______________
TOTAL:				 $______________
q Check #_______________	 q Cash
q Visa		 q MC		 q Discover	 q AMEX
I agree to pay the total amount according to the card issuer agreement.
Credit Card # ____________________________________________________________________________ Exp Date __________________
Office Depot Card Number_________________________________	 Name___________________________________________________
Applicant Signature:______________________________________	 Chamber Representative(s): _________________________________
Signature___________________________________________________
Membership Level: ___________________________________________________________________________
(will be used on the Chamber web site, address will not be exposed; Yahoo/AOL members may not receive information due to SPAM blockers)
Parent company ID#
_________________
(office use only)
Please attach a business card to the application.
(will be used in printed Membership Directory and on web site)
(will be used in printed Membership Directory)
CB122209
(will be used by the Chamber to communicate with you)
www.lvchamber.com
Login: ________________________________________
Password:______________________________________
(office use only)
Terms & Conditions
	 • Memberships are held in the name of the business/firm.
	 • One person (designated member) represents the firm, is entitled to one vote, enjoys discounted rates on certain programs,
receives all mailings and may participate on committees.
	 • The annual dues paid by each member include a subscription to the Chamber’s monthly news magazine, The Business Voice.
	 • All memberships shall be continuous unless cancelled (A) in writing by the member, (B) by the Chamber for non-payment of dues,
or (C) for non-compliance with Chamber policies.
	 • Membership dues investment is non-refundable.
	 • Membership plaques are the property of the Las Vegas Chamber of Commerce and are required to be returned if membership is
cancelled for any reason.
	 • Membership in the Las Vegas Chamber of Commerce may be revoked according to the terms set forth in its bylaws.
	 • IRC section 6033 (e)(1)(A): requires exempt organizations that pay / incur non-deductible lobbying expenses to notify members of
its reasonable estimate of the portion of the dues allocated to non-deductible lobbying expenses. Accordingly, 10% of your dues
investment is considered allocable to lobbying expenses and is not deductible for federal income tax purposes. 90% of your dues
investment usually is tax deductible as an ordinary and necessary business expense. *
	 • The Chamber may send communications to the organizational e-mail, personal e-mail and fax number provided to keep you
updated on urgent business issues, recent referrals and referral summaries, Chamber events and Chamber programs.
	 • By providing e-mail addresses and a fax number, you are stating you are authorized to and hereby consent for the company/orga-
nization to receive faxes and/or e-mails sent by or on behalf of the Las Vegas Chamber of Commerce.
	 • If a member's dues shall become delinquent for a period of thirty (30) days, the delinquent member may no longer be in good
standing and shall forfeit the right to vote and a notice of delinquency shall be given to the delinquent member. If delinquent
dues are not brought current within ten (10) days after a notice of delinquency, membership may be terminated by designated
Chamber administrative staff.
	 • Any member wishing to indicate on his/her business web site that he/she is a member of the Chamber shall do so only with the
consent of the Chamber and in a form approved by the Chamber.
	 • Dues are for a period of one year from date of inception.
	 • Employee counts are reviewed annually and dues are adjusted up or down based on employee count at time of renewal.
	 • Proud Member logos are for member use only and must be dropped from all materials upon termination of membership for any reason.
	 • Membership is not a guarantee of health coverage in the Chamber Health Plan.
	 • Membership is not contingent upon approval of any business for the Chamber Insurance program.
	 • Membership dues will not be refunded if member does not elect or secure insurance through the Chamber Health Plan for any reason.
*Your optional BIZPAC contribution is NOT tax deductible as an ordinary business expense.

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Las Vegas Chamber of Commerce Member Application 2009

  • 1. Membership Application Organization Name:_________________________________________________________________________________________________ Street Address:__________________________________________________________________ Suite: _____________________________ City:_____________________________________ State:________________ Zip:__________--_______ County:_____________________ Mailing Address: (if different than street address) ________________________________________________________________________________ City:_____________________________________ State:________________ Zip:__________--_______ County:_____________________ Organizational E-mail Address: (example: info@mycompany.com) __________________________________________________________________ Contact E-mail Address: _____________________________________________________________________________________________ Web Address:______________________________________________________________________________________________________ Main Telephone:_________________________ Fax:______________________________________ Cell Phone:________________________ Designated Member: Mr. Ms. Mrs. Dr. First Name:___________________________ Last Name:___________________________ Title: ____________________________________ Home Address:_____________________________________________________________________________________________________ City:_____________________________________ State:________________ Zip:_________________ County:_____________________ Business Classification - Print (will be used in printed Membership Directory and on Web site): ________________________________________________ Business Classification - Web (will be used on Web site only): _____________________________________________________________________ Number of permanent full-time employees in Las Vegas area: ______________ part-time: _____________ (By signing, you are stating that you have read and agree to the terms and conditions on the reverse side.) Thank you for your support and interest in the Las Vegas Chamber of Commerce. Please keep the last copy of the application for your tax records. * BIZPAC contribution is voluntary and may not be declared as a business expense. Las Vegas Chamber of Commerce Attn: Sales Department 6671 Las Vegas Blvd. South | Suite 300 | Las Vegas, NV 89119 Phone:702.641.5822 | Fax: 702.735.2011 | www.lvchamber.com Membership #: __________________ App. Date: __________________ Office Use Only Annual Dues: $______________ Admin. Fee: (first year only) $______________ Per Employee Fee: $______________ BIZPAC Contribution*: $______________ TOTAL: $______________ q Check #_______________ q Cash q Visa q MC q Discover q AMEX I agree to pay the total amount according to the card issuer agreement. Credit Card # ____________________________________________________________________________ Exp Date __________________ Office Depot Card Number_________________________________ Name___________________________________________________ Applicant Signature:______________________________________ Chamber Representative(s): _________________________________ Signature___________________________________________________ Membership Level: ___________________________________________________________________________ (will be used on the Chamber web site, address will not be exposed; Yahoo/AOL members may not receive information due to SPAM blockers) Parent company ID# _________________ (office use only) Please attach a business card to the application. (will be used in printed Membership Directory and on web site) (will be used in printed Membership Directory) CB122209 (will be used by the Chamber to communicate with you) www.lvchamber.com Login: ________________________________________ Password:______________________________________ (office use only)
  • 2. Terms & Conditions • Memberships are held in the name of the business/firm. • One person (designated member) represents the firm, is entitled to one vote, enjoys discounted rates on certain programs, receives all mailings and may participate on committees. • The annual dues paid by each member include a subscription to the Chamber’s monthly news magazine, The Business Voice. • All memberships shall be continuous unless cancelled (A) in writing by the member, (B) by the Chamber for non-payment of dues, or (C) for non-compliance with Chamber policies. • Membership dues investment is non-refundable. • Membership plaques are the property of the Las Vegas Chamber of Commerce and are required to be returned if membership is cancelled for any reason. • Membership in the Las Vegas Chamber of Commerce may be revoked according to the terms set forth in its bylaws. • IRC section 6033 (e)(1)(A): requires exempt organizations that pay / incur non-deductible lobbying expenses to notify members of its reasonable estimate of the portion of the dues allocated to non-deductible lobbying expenses. Accordingly, 10% of your dues investment is considered allocable to lobbying expenses and is not deductible for federal income tax purposes. 90% of your dues investment usually is tax deductible as an ordinary and necessary business expense. * • The Chamber may send communications to the organizational e-mail, personal e-mail and fax number provided to keep you updated on urgent business issues, recent referrals and referral summaries, Chamber events and Chamber programs. • By providing e-mail addresses and a fax number, you are stating you are authorized to and hereby consent for the company/orga- nization to receive faxes and/or e-mails sent by or on behalf of the Las Vegas Chamber of Commerce. • If a member's dues shall become delinquent for a period of thirty (30) days, the delinquent member may no longer be in good standing and shall forfeit the right to vote and a notice of delinquency shall be given to the delinquent member. If delinquent dues are not brought current within ten (10) days after a notice of delinquency, membership may be terminated by designated Chamber administrative staff. • Any member wishing to indicate on his/her business web site that he/she is a member of the Chamber shall do so only with the consent of the Chamber and in a form approved by the Chamber. • Dues are for a period of one year from date of inception. • Employee counts are reviewed annually and dues are adjusted up or down based on employee count at time of renewal. • Proud Member logos are for member use only and must be dropped from all materials upon termination of membership for any reason. • Membership is not a guarantee of health coverage in the Chamber Health Plan. • Membership is not contingent upon approval of any business for the Chamber Insurance program. • Membership dues will not be refunded if member does not elect or secure insurance through the Chamber Health Plan for any reason. *Your optional BIZPAC contribution is NOT tax deductible as an ordinary business expense.